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Associations between visual impairment, incident falls and fall frequency among older asians: longitudinal findings from the Singapore Epidemiology of Eye Diseases study
  1. Preeti Gupta1,2,
  2. Ryan Eyn Kidd Man1,2,
  3. Eva K Fenwick1,2,
  4. Chaoxu Qian1,
  5. Ralene Sim1,
  6. Shivani Majithia1,
  7. Yih Chung Tham1,2,
  8. Charumathi Sabanayagam1,2,3,
  9. Tien Yin Wong1,2,3,
  10. Ching-Yu Cheng1,2,3,
  11. Ecosse Luc Lamoureux1,2,3
  1. 1Singapore Eye Research Institute, and Singapore National Eye Centre, Singapore
  2. 2Duke-NUS Medical School, Singapore
  3. 3National University of Singapore, Singapore
  1. Correspondence to Dr Ecosse Luc Lamoureux, Ophthalmology, Singapore Eye Research Institute, Singapore, Singapore; ecosse{at}


Background Association between baseline visual impairment (VI) bilaterality and severity, and associated causes; and incident and frequent falls at 6 years in a multiethnic Asian population aged ≥60 years.

Methods It is a population-based prospective cohort study. Visual acuity was clinically measured at both visits. Self-reported incidence and frequency of falls were defined as having no fall at baseline but having one fall and ≥2 incident falls in the 12 months prior to the follow-up visit, respectively.

Results Of the 1972 older participants (mean age (SD): 67.37 (5.4) years), 253 (12.8%) and 69 (3.5%) reported at least one fall and ≥2 falls, respectively, at a 6-year follow-up. After multivariable adjustments, baseline bilateral VI, but not unilateral, was associated with higher odds of any incident falls (mild bilateral VI: OR=1.79, 95% CI 1.07 to 2.98; moderate-severe VI in one eye and mild VI in the other eye: OR=1.58, 95% CI 1.01 to 2.47). However, having any form of bilateral VI (OR ranging between 2.46 and 4.32; all p<0.05) and even unilateral mild VI (OR=2.34, 95% CI 1.09 to 5.03) significantly increased the odds of incident frequent falls, compared with bilateral normal vision. VI caused by correctable (OR=2.02, 95% CI 1.19 to 3.44) and uncorrectable (OR=3.09, 95% CI 1.08 to 8.80) eye conditions were both associated with greater odds of incident frequent falls, compared with no VI.

Conclusions Baseline bilateral but not unilateral VI conferred nearly two-fold higher odds of incident fall. Importantly, even mild unilateral VI conferred a substantially greater likelihood of frequent falls from correctable and uncorrectable conditions.

  • vision
  • epidemiology
  • public health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors PG and ELL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. ELL is the gurantor. Study concept and design: PG, CS, C-YC, TYW, ELL. Acquisition, analysis, or interpretation of data: PG, REKM, EKF, C-YC, TYW, ELL. Drafting of manuscript: PG, REKM, EKF and ELL. Critical revision of the manuscript for important intellectual content: PG, REKM, EKF, CQ, RS, SM, YCT, CS, TYW, C-YC, ELL. Obtained funding: TYW, C-YC and CS. Statistical analysis: PG. Administrative, technical or material support: TW, C-YC and CS. Study supervision: PG, TYW, CS, C-YC, ELL.

  • Funding The Singapore Epidemiology of Eye Diseases study was funded by the National Medical Research Council (NMRC-Singapore), Grant Number NMRC/CIRG/1488/2018 and NMRC/OFLCG/004a/2018. The grant funding bodies had no roles in design, conduct or data analysis of the study, nor in manuscript preparation and approval.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.